声辐射力脉冲成像和天冬氨酸转氨酶与血小板比值诊断酒精性肝病肝纤维化程度的价值

Clinical value of acoustic radiation force impulse imaging and AST/PLT ratio index for quantitatively evaluating the hepatic fibrosis degree in patients with alcoholic liver disease

目的探讨声辐射力脉冲成像（ARFI）技术和天冬氨酸转氨酶与血小板比值（APRI）诊断酒精性肝病（ALD）肝纤维化程度的临床价值。方法108例ALD患者应用ARFI技术对肝脏弹性进行检测，获得剪切波速度（SWV）同时计算APRI，所有患者均于检测后1周内行肝穿刺活检，以病理结果为金标准，比较SWV和APRI对ALD肝纤维化的诊断价值。结果ALD肝纤维化S0-S4期的SwV分别为（1．11±0．08）m／s、（1．24±0．17）m／s、（1．50±0．35）m／s、（2．01±0．70）m／s及（2．13±0．68）m／s，APRI分别为0．18±0．08、0．19±0．13、0．37±0．24、0．75±0．91及0．75±0．63。SWV和APRI均与肝纤维化分期存在正相关，相关系数分别为0．60和0．55（P=0．000）。swv诊断ALD肝纤维化ROC曲线下面积分别为≥S1期0．88，≥S2期0．81，≥S3期0．83，S4期0．82；APRI对应的ROC曲线下面积分别为0．65、0．80、0．78及0．78。结论对于定量诊断ALD肝纤维化程度，ARFI技术较APRI有更高的诊断价值，具有良好的临床应用前景。

Objective To investigate the diagnostic value of the acoustic radiation force impulse （ARFI） technology and AST/PLT ratio index （APRI） for the assessment of the hepatic fibrosis in patients with alcoholic liver disease （ALD）. Methods Ultrasound elastography of liver was performed in 108 ALD patients by ARFI technology. In the meanwhile, the APRI values were calculated. All patients underwent liver biophy one week later and the pathologic foundings were taken as golden standard. The diagnostic value of ARFI and APRI were comparatively analyzed. Results The ARFI and APRI values of hepatic fibrosis from SO to $4 stages in ALD patients were （1.11 ± 0.08）m/s, （1.24 ± 0.17）m/s, （1.50 ± 0.35）m/s, （2.01 ± 0.70）m/s, （2.13 ± 0.68）m/s and 0.18 ± 0.08, 0.19 ± 0.13, 0.37 ± 0.24,0.75 ± 0.91,0.75 ± 0.63, respectively.Both ARFI and APRI had a positive correlation with hepatic fibrosis staging and the Spearman coefficients were 0.60 and 0.55. The areas under the ROC curves of ARFI and APRI for the diagnosis of hepatic fibrosis were 0.88, 0.81, 0.83, 0.82 and 0.65, 0.80, 0.78, 0.78,respectively. Conclusion ARFI technology has better diagnostic value for quantitatively evalutating the hepatic fibrosis of ALD patients compared wth APRI.